The data and graphs presented here were compiled towards the end of December 2021, just as the peak of wave three appears to have been reached – or at least the first of the peaks. Without the use of a crystal ball it is safe to say that we are expecting the next few months to be difficult for Plymouth, the country and the world; though with the vaccination programme, we should continue to see the much smaller proportion of people losing their life to COVID-19, compared to earlier in the pandemic.
COVID-19 is the disease caused by infection with a new virus called severe acute respiratory syndrome coronavirus 2 or SARS-CoV-2. This is a type of virus called a coronavirus, known to be of concern because they can be very severe and spread easily. There are many different coronaviruses, some of which exist in humans but a large number in different animals. Every now and then, the right conditions are met for the virus to spread into humans; and sometimes an infected human can spread the virus to others. This kind of a novel virus is of great concern as humans are unlikely to have any immunity and the virus can be very harmful.
It was first identified in Wuhan, China, in December 2019; despite a lock down, the virus was not contained and by early March 2020, though the rate of new cases appeared to be dropping in Wuhan and China as a whole, there were several areas of the world where concerns have heightened; Italy, South Korea and Iran in particular. The early indications was that this virus was creating a significant illness which was around 10 times more lethal than influenza.
The virus spreads through the air, usually as droplets and occasionally finely dispersed particles in the air. Droplets tend to fall from the air quickly and so simply keeping your distance from infected people can reduce spread; however, this can be harder than it seems and needs national intervention.
In the UK, initially early cases had connections through travel or close contacts (there were thought to be around 1,000 separate incidents), we quickly started to see evidence of community spread meaning that the disease had reached the UK.
On 13th March 2020, we became aware of the first case in a Plymouth resident; and by the 23rd March 2020, the need for a national lockdown was announced.
Between 13th March 2020 and spring of 2021, we have had a cycle of COVID-19 numbers being suppressed by lockdown measures, but then increasing again as those measures are reduced. Plymouth has on the whole followed the same trend as England though we have been at a lower level for most of the pandemic. We have seen two very significant mutated versions of the virus in that time, ones where a significant advantage was conferred due to the mutation making it able to out-compete the existing variant.
In December 2020, the UK vaccination programme began. This was a very significant point in the pandemic response; an intervention which reduced spread but most importantly prevented serious disease and deaths.
We really started to see the benefits of vaccination around spring 2021, when sufficient people who were vulnerable had been double-vaccinated and we saw hospitalisation and death rates reducing in those groups.
We started along the roadmap for the opening up of the economy, and it was during this time that we really began to see how people’s behaviours could so easily change the course of the pandemic. The UEFA European Football Championships combined a strong motivation for social mixing, with one of the first opportunities to mix after restrictions were eased. Whether at organised games, watching at public venues, or just meeting in their own living room with family and friends, we saw a large peak in people with COVID-19 and in those isolating as contacts. The spike that we saw in Plymouth towards the end of July was extremely high and although it did fall off quickly, we have been left with case rates around 350 per 100,000 in a seven day period – not far short of 1,000 people testing positive in a week. Unfortunately, the number of people in hospital has also been too high over this period; obviously this is bad in itself, but also because of the impact COVID-19 is having on our healthcare system. When rates are high, we have more people in hospital, and having people in hospital with a very infectious disease makes everything more difficult for staff to handle. The threat of spread within healthcare facilities is a very real risk. We also know that people in hospital with COVID-19 can have long stays, especially for those more severely impacted and needing intensive care. Having these Intensive Care Unit (ICU) beds occupied reduces the number of patients that can have their planned surgery with many people having to wait too long for treatment. In addition, when case rates are high, staff are affected and so we have reduced workforce able to be in work – of course this is important in health and social care, but also many other key jobs; lorry drivers bringing us supplies, bus drivers getting people to work, supermarket workers making sure the shelves are topped up.
At the time of writing, we know that even with the vaccination programme, we should expect a difficult winter.
Figure 1. Case rates of COVID-19 from the start of the pandemic. In the early stages, testing was not widely available so the true rates will have been higher. Source: UK Government.